Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 12084 | MS |
NPI | 1104900968 |
---|---|
Provider Name | Dr. Jon Stephen Ashley |
First Address | Greenwood, MS 38935-1410 |
Second Address | Greenwood, MS 38930-4030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 23/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000121529 | (05) | MS |
E66059 | (02) | MS |
P01713169 | RAILROAD MEDICARE PTAN (01) | MS |